By Carolyn L. Rosenblatt, R.N., B.S.N., Attorney Falls are one of the most common reasons aging persons enter nursing homes. Falls are a major cause of serious injury in older adults. You’ve seen the common scenario: Mom falls at home and breaks a hip. She has surgery, but it leaves her with difficulty walking. She can’t live alone anymore and needs help with bathing now. She doesn’t have the money for assisted living. She spends what she has on help at home until the money runs out. Then, she has no choice but to go on Medicaid, and move to a nursing home, as there is no one else who can take care of her. If this isn’t what we want for our loved ones as they age, we, as their family and friends need to look at why falls are so common, and what we can do to help prevent them. Based on my nursing experience, I can say that many elders have no idea that they are so unsteady on their feet. Listing as badly as a sailboat with a broken mast, they’ll keep on refusing help, even as they hold onto furniture to try to walk straight. “I’m fine, dear” may be what you hear if you bring up your concerns. What to do? First, we need to observe our aging parents carefully, and stop making excuses for their unsteady walking. “She’s just tired”, or “she got up too fast” are not explanations for long term poor balance. Poor balance with walking can be a result of factors such as reduced blood flow to the brain, which can accompany aging, reduced muscle strength and therefore reduced ability to right one’s self, medication side effects, and disease processes. These things combined, together with the slowed reaction time to something which causes an elder to start to lose his balance, can lead to falls anywhere. Facing the truth that aging can lead to poor balance and increased fall risk is a first step. Another step is to get a good assessment of the elder’s walking ability from an objective person, such as a physical therapist or occupational therapist. Your loved one’s doctor will need to order the assessment, but a caring physician should have no difficulty abiding by your request, based on your observation that Mom or Dad has had falls or has trouble staying steady on her or his feet. A fall is which your elder is not injured is a gift: you get a free warning that you need to act without paying the price of something more serious, like a stay in the hospital or loss of mobility altogether. The therapist who does the assessment of your loved one’s fall risk and ability to walk safely is also a good resource for tips on how to make the home safer. Removing all throw rugs is a basic, common sense step, often overlooked by family. Moving obstacles out of walking areas, such as bathrooms and hallways is another basic. Introducing walking aids such as a cane, or a walker can do much to preserve independence and help an elder to stay at home. Maybe your elder will want to whack you with that cane for merely suggesting that it’s needed, but give it a try. Finally, you need to step up your vigilance when you first see signs that an aging loved one is starting to be shaky on her feet. This is one of the early warnings of increasing frailty, and may be hard to face for both of you. But being more watchful of your aging parent can be the best protection she has. You might be the first one to suggest help at home, or a new, walk-in tub enclosure. You might be the first to offer a therapist’s evaluation or a different living situation. There’s no assurance that Mom or Dad will accept what you suggest or say, but it is the best you can offer. Waiting to bring up the subject of walking safety until an elder gets hurt from falling is never a good choice. It could be too late. Mobility can be lost for good with one serious tumble. So, step up, speak up, and take the lead. Your elder’s safety can depend on it. For useful tips and strategy about having the difficult conversation with elders, see Ms. Rosenblatt’s book, The Boomer’s Guide to Aging Parents, and our articles, all available at AgingParents.com.